Sex therapists help breast cancer patients get their groove back


Therapists help breast cancer patients get their groove back with husbands and lovers

Special to The Miami Herald

When Lulu was diagnosed with breast cancer in 2005, she wasn’t thinking about how the disease would affect her and her husband’s sex life.

Staying alive was the first thought of the North Miami woman.

“The moment that I remember the most was standing in the shower holding clumps of hair in my hand. ‘I was like, Wow, now I’m officially a cancer patient,’ ’’ she said.

Lulu had her left breast removed and underwent chemotherapy. Like many women, Lulu, then 44, was pushed into early menopause.

At first, sex was out of the question.

“You have surgery. You’re missing a breast. You’re missing your hair. It wasn’t really on his side; it was about me. I felt disfigured,” said Lulu, now 50, and married for 26 years.

One of the most common side effects of chemotherapy is vaginal dryness, which can cause pain during intercourse. Lulu’s oncologist, Dr. Elisa Krill-Jackson, at Mount Sinai Medical Center in Miami Beach, suggested lubricants. They didn’t work.

Her doctor then recommended that Lulu and her husband see Dr. Christina Pozo-Kaderman, a clinical psychologist and licensed sex therapist at Mount Sinai.

Many doctors don’t bring up sexual issues, either because they are uncomfortable with the topic, or because if they do, and the center doesn’t have a sex therapist, “they’ve just opened up a can of worms,” said Pozo-Kaderman.

It took Lulu a year and a half to be interested in sex again. She learned from Pozo-Kaderman that becoming sexually active again with your partner is a process.

She recommends that women include their lovers in their recovery.

“If you’re going to be sexually intimate, then you need to use a lubricant, and it should be used liberally, and involve the partner in it – have your partner apply it – make it part of foreplay,” Pozo-Kaderman said. Kaderman recommends the brand Astroglide because it is water-based. To keep your vagina moisturized regularly, she recommends also using a vaginal moisturizing cream such as Replens.

“Use it every other night, before bedtime, that way it doesn’t leak out during the day,” she said.

Pozo-Kaderman doesn’t just give technical advice; she gives couples advice on how to spark their sexual desire.

“Part of what I do on an individual basis is give them assignments, such as going with your partner to the different sex toy shops, and shopping for lingerie,” she said.

For Lulu, some of Pozo-Kaderman’s recommendations began with taking walks together, holding hands or cooking dinner together.

“Feel comfortable with yourself first, and feel comfortable with each other second,” Lulu said.

Ada Maria Nimo, 51, of Miami Beach can relate. She found a lump in her left breast in 2002 and had a lumpectomy. She was divorced at the time.

“You’re looking at yourself in the mirror, and you’re seeing someone else,” she said. “Right off the bat, your hair falls out in chunks — it’s incredible.”

Before cancer, Nimo had straight red hair. When her hair started growing back, it was brown and wavy.

“When it comes back, you don’t care what color it is — it could be green — but the fact is, it’s still different than what you’re used to seeing in the mirror,” she said.

Nimo has since remarried, but breast cancer catapulted her too into early menopause.

“I consider myself a success story,” she said. “Even though I couldn’t have kids, having your life and your health back is what matters.”

Dr. Teresa Neira, a sex therapist and clinical social worker at the Courtelis Center within the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, says one of the keys to rekindling a sex life is understanding the physical as well as the emotional.

“It’s important to find out what the source is. Is it loss of interest in sex? Is it a physical feeling? Is it body image issues? Is it the reconstructed breasts — the nipples? They call it the Barbie breasts,” she said.

The nipples are one of the hardest parts of the breasts to reconstruct, said Mount Sinai’s Krill-Jackson. It can take several surgeries, and even then, sensation won’t be restored.

Neira stressed the importance of staying connected with your spouse or lover.

“Sometimes you can replace sex with intimacy,” she said. “Just because you can’t connect your sexual organs, doesn’t mean you can’t connect. And when you don’t connect, a lot of times, that’s when we see infidelity.’’

During treatments, many couples may not have sex for more than a year, she said, noting it’s important to keep the couples connected in other ways.

“You want this patient to live, yes of course, but at the end of this treatment, if they are facing divorce…” she said.

She suggests being open to different sexual encounters: oral sex, mutual masturbation, sex toys, turning the lights down low and caressing each other.

Lulu took what she considers a proactive approach to getting her sex life back on track.

“They are afraid to approach you. You have to make them feel like, ‘It’s OK,’ ” she said.

She credits her marriage’s survival to love and communication.

“Some conversations you need to have with your partner after you’re feeling well include, ‘Do you want to have sex?’ If he says, ‘Yes,’ then you need to ask him, ‘Do you want to have sex with me, your wife? You never know, he may not be attracted to you anymore.”

Her husband answered, “yes” to both of those questions. The next step she compared to making a doctor’s appointment.

“The conversation needs to go something like this,” she said:

“Husband, I have a problem.’’

“Yes, what it is it?’’

“I want to have sex with you.’’


“How about tomorrow at 4 p.m.?’’

She admits it doesn’t sound like the most romantic way to kick off things, but if you don’t schedule it, it might never happen.

“All men need is to see a naked body and he’s ready, so it’s up to you to be ready. Whatever you need to do, buy sexy lingerie, walk around the house with it, whatever you need to do, because he’s ready.”

Their first sexual rendezvous post-cancer was well, different from when they were in their 20s. “We didn’t completely fail at it, but it wasn’t a home run either,” she said, laughing.

“Now it’s like, ‘I’m not planning a funeral, I’m planning the rest of my life,’ ” she said.

And her future plans are to include sex toys in their sexual fun.

“We’re not there yet; we haven’t graduated.”

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